CPT code 19325: Breast augmentation, prosthetic implant placement2026 Medicare rate & RVUs in Texas
Breast augmentation with an implant increases breast volume; report it for implant placement performed for augmentation rather than postmastectomy reconstruction.
CMS doesn’t publish an office rate for 19325 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 19325 covers
This operation increases breast volume by placing a prosthetic implant in the breast. A plastic surgeon typically performs it in a hospital outpatient department or ambulatory surgery center for a patient seeking enlargement of the breast. It is distinct from implant placement as part of breast reconstruction after mastectomy.
Report the service when the operative record supports implant placement for augmentation, rather than reconstruction or implant removal. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple procedure reduction. For bilateral augmentation reported with modifier 50, CMS pays at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 19325 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $575.67 |
| Beaumont, TX | Unavailable | $539.94 |
| Brazoria, TX | Unavailable | $555.12 |
| Dallas, TX | Unavailable | $560.50 |
| Fort Worth, TX | Unavailable | $558.62 |
| Galveston, TX | Unavailable | $557.99 |
| Houston, TX | Unavailable | $585.08 |
| Rest of Texas | Unavailable | $548.49 |
How the 19325 rate is calculated
Each of 19325’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 19325
RVUs × geographic indexes × conversion factor
Work7.92
7.92 RVUs× 1.000 GPCI
Practice expense7.55
7.55 RVUs× 1.000 GPCI
Malpractice1.48
1.48 RVUs× 1.000 GPCI
Adjusted RVUs
16.9500
Conversion factor
$33.4009
Medicare rate
$566.15
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 19325
19325 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 19325
Breast augmentation, prosthetic implant placement
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 19325
Breast augmentation, prosthetic implant placement
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
19325 without 50 · national facility
$566.15
Breast augmentation, prosthetic implant placement
19325-50 · Bilateral: 150%
$849.23
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
19325 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 19340Breast implantImmediate postmastectomy placement
- Choose 19340 for implant placement as part of breast reconstruction at the mastectomy, not for augmentation of an intact breast.
- 19342Breast implantSeparate day from mastectomy
- Choose 19342 for implant placement in a separate procedure during breast reconstruction after mastectomy.
- 19316Breast liftPtosis correction
- This code enlarges the breast with an implant; 19316 lifts and reshapes the breast without defining implant augmentation.
- 19318Breast reductionTissue removal and reshaping
- Choose 19318 for breast reduction. This code is for enlargement with an implant.
19325 billing questions
How is this different from implant placement after mastectomy?
This code is for implant placement to enlarge the breast. Codes 19340 and 19342 describe implant placement in breast reconstruction, distinguished by whether placement occurs at the mastectomy or later.
Can a breast lift be reported in the same session?
Code 19316 may be reported when a breast lift is also performed and documented as a separate service. The operative note should describe both the implant augmentation and the lift.
How should bilateral augmentation be reported?
Use modifier 50 for a bilateral procedure. CMS pays bilateral reporting at 150%.
What happens when another procedure is performed during the same session?
Under the standard multiple procedure reduction, CMS pays the highest-valued procedure in full and pays the other procedure or procedures at 50%.
What documentation supports assistant-at-surgery payment?
The record must document the medical necessity of the assistant's participation. CMS does not permit co-surgeons or team surgery for this code.
Which postoperative services are included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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